Stakeholder considerations on acceptability and implementation of a novel rapid test for acute HIV infection: A qualitative study in Indiana.

Acute HIV infection (AHI) is the most infectious stage of HIV, yet existing rapid tests cannot reliably detect HIV in this early phase and require up to 90 days post-exposure for accurate results. Laboratory-based nucleic acid tests can detect AHI but are often inaccessible to high-risk populations with limited healthcare access. Novel rapid AHI tests are in development to bridge this gap by enabling earlier, decentralized detection. This study aims to explore the acceptability and future implementation considerations of such a test through engagement with clients (n = 5) and staff (n = 14) of Indiana-based HIV service organizations. Guided by human-centered design frameworks, semi-structured interviews examined experiences with HIV testing, acceptability of a proposed novel rapid AHI test that could detect infection about one month earlier but would require longer time to results (~60 minutes), and preferences for potential end-users (self, community health workers (CHW) or peers). Transcripts were thematic analyzed. Participants strongly supported earlier detection despite longer wait times, describing the trade-off as worthwhile for reducing transmission, initiating treatment sooner, and alleviating anxiety following high-risk exposures. Clients emphasized the benefits of convenience and peace of mind, particularly for people who use drugs or experience stigma. Staff highlighted the potential to retain individuals who are often lost to follow-up and to strengthen linkage to care. Concerns focused on organizational feasibility of accommodating longer test times and client expectations shaped by existing "rapid" tests. CHW/peer-led testing was preferred due to their ability to build trust, provide education and navigation, while self-testing was viewed as useful for overcoming barriers such as stigma and access, though concerns about accuracy, interpretation, and lack of counseling were noted. Stakeholder insights underscore the importance of accuracy, usability, affordability, and integration of counseling and care navigation in designing and implementing AHI rapid tests to maximize their impact among high-risk populations.